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Congress and the Fed Could Ensure Universal Protection During the Pandemic

Congress and the Fed Could Ensure Universal Protection During the Pandemic

No matter how well or poorly the federal government addresses the overall economic crisis, millions of vulnerable people will be left unprotected.  Homeless people, incarcerated people, immigrants, people in fringe, off-the-books employment like day labor—unless steps are taken that specifically target them, they are staring into the abyss.

This is fundamentally a local problem.  States, counties and cities know where the needs are.  They have existing ties through social service agencies and their connections to nonprofits.  This is where the expertise lies, but their budgets, lean in good times, are in free-fall right now.

The solution is straightforward.  Congress should authorize the Federal Reserve to purchase specially designated state and municipal bonds floated for the specific purpose of serving the health, housing, food and other essential needs of vulnerable populations.  There should be no limit to the amount that can be borrowed.  And the Fed should purchase these bonds with the intention  of retiring them.  Effectively, the Fed would be using its money-creating power to finance social protection at the local level.

This facility can be created immediately, with auditing to follow when practicable.  There should be no delay in meeting the urgent human needs that will otherwise go unaddressed by more conventional policies.

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Patent Protection vs Orphan Drug Market Exclusivity

Massive Scandal or a Massive Misunderstanding of Regs and Laws for Orphan Drugs

Most of you know, I have been writing on healthcare for a long time and much of it has been negative about healthcare and the costs. I am not defending Gilead’s marketing of Remdesivir; but, a few articles (Common Dreams, The Intercept, etc.) written and the pundits amongst us appear to have misunderstood the issue for Remdesivir’s status.

I can understand why people would become excited and upset with the actions by the FDA to “designate” Remdesivir an orphan drug “candidate (note the quote notation).” In the past, I have found myself to be distracted by headlines (Intercept) which lead me to believe something bad was to come about only to find out it was not as serious as described in the headlined article. With all the issues we are faced with from COVID 19, the half attempt to mandate a lockdown of us in our homes, people “still” clustering, and our government led by a jackass; it is easy to get agitated.

Some thoughts; Given the pandemic, COVID 19 appears to be the exact opposite of a rare disease and describing a new drug for it as an orphan-drug does sound absurd.

A Little History

The seventies found incentives for profit-making drug companies not aligning with the needs of people having rare diseases. Drug Development of new drugs was expensive even 40 years ago. Companies concentrated on needed new therapies and pharmaceuticals potentially having high customer demand yielding increased profits rather than focusing  on those therapies and pharmaceuticals needed by a handful of patients. In 1983, the Orphan Drug Act was passed to encourage R&D for these drugs.

The FDA was given the power to grant a drug “orphan” status and to compounds without patent protection. If a company got its product “approved” as an orphan drug, it gained a period of market exclusivity of seven years. No one else was allowed to sell the same product to treat that specific disease. Additionally, the costs associated with developing that orphan drug including payroll for scientists, and miscellaneous costs were subject to a tax credit. Under the Orphan Drug Act, more than 800 orphan drugs and biologics have been approved by the FDA out of more than 5,300 applications. The Whys and Whats after the leap   .   .   .

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AFL-CIO has a Plan

AFL-CIO has a Plan

From the AFL-CIO website:

PRIORITIES OF THE LABOR MOVEMENT TO ADDRESS THE CORONAVIRUS:

PROTECT FRONT-LINE WORKERS
  • Streamline approaches for allocating and distributing personal protective equipment to working people in greatest need.
  • Issue a workplace safety standard to protect front-line workers and other at-risk workers from infectious diseases.
  • Provide workplace controls, protocols, training and personal protective equipment.
  • Provide clear, protective federal guidance for different groups of workers with different needs.
  • Increase funding for the Occupational Safety and Health Administration and Mine Safety and Health Administration for additional inspectors and health specialists, and for developing and implementing an infectious disease standard.
MITIGATE THE BROADER PUBLIC HEALTH CRISIS

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Meanwhile, another DOJ move from Barr

Meanwhile while we are pre-occupied with corvid-19 comes this news from  Rolling Stone:

The Trump Department of Justice has asked Congress to craft legislation allowing chief judges to indefinitely hold people without trial and suspend other constitutionally-protected rights during coronavirus and other emergencies, according to a report by Politico’s Betsy Woodruff Swan.

The DOJ has requested Congress allow any chief judge of a district court to pause court proceedings “whenever the district court is fully or partially closed by virtue of any natural disaster, civil disobedience, or other emergency situation,” according to draft language obtained by Politico. This would be applicable to “any statutes or rules of procedure otherwise affecting pre-arrest, post-arrest, pre-trial, trial, and post-trial procedures in criminal and juvenile proceedings and all civil processes and proceedings.” They justify this by saying currently judges can pause judicial proceedings in an emergency but that new legislation would allow them to apply it “in a consistent manner.”

Norman L. Reimer, executive director of the National Association of Criminal Defense Lawyers, told Politico the measure was “terrifying,” saying, “Not only would it be a violation of [habeas corpus], but it says ‘affecting pre-arrest.’ So that means you could be arrested and never brought before a judge until they decide that the emergency or the civil disobedience is over. I find it absolutely terrifying. Especially in a time of emergency, we should be very careful about granting new powers to the government.”

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For a Universal Debt and Rental Moratorium

For a Universal Debt and Rental Moratorium

Incomes are collapsing throughout the economy, and both businesses and individuals face a crisis in meeting fixed payments they can’t control.  The most direct step we can take is to temporarily suspend these payment obligations.

Suppose the government were to announce that, starting immediately, all stipulated debt and real estate rental payments were to be suspended for all borrowers and renters.  This moratorium could have an ending date of, say, two months in the future, with the option of extending it if circumstances require.  No interest would accrue to any of these obligations; in effect, we would be stopping the clock on them for a period of time.

Of course, if nothing else were done this would shut down the credit and rental systems completely for the duration of the moratorium, so a stipulation would have to be added that it applies only to debt or rental obligations established at the time of the announcement.  We’d all have to keep two sets of books, one for pre-announcement loans and rentals, the other for post.

International obligations are somewhat more complicated, but the economic heft of the US is great enough that these conditions could probably be imposed unilaterally on foreign counterparties, especially if the logic of this step persuaded other countries to adopt a similar course of action.

A debt moratorium would dampen some channels of financial instability and provide greater security for most participants in the economy.  By itself, however, it would not address the gaping hole in the real economy caused by shutting down whole sectors of goods and services production.  That requires other forms of stimulus.

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A Rehash, Stimuli Considered, And ACA Healthcare Insurance Assistance

I am sure by now many of you have read what the gov is and is not doing for us. The later is more prevalent as can be witnessed in the stimuli being offered. I am going to ask you to pay attention to the last item on ACA Healthcare Insurance. Whether you qualified or not in the past, you may be eligible for assistance now. I have broken this out into 4-points of which many of us might find ourselves. If you questions, PLEASE ASK, I will try to answer.

The Rundown

Goldman Sachs projects that after a 30% spike in jobless claims last week, to 281,000, new claims will hit 2.25 million this week — an unprecedented surge.

Treasury Secretary Steven Mnuchin warned Republican senators Tuesday morning that without action the coronavirus pandemic could drive up US unemployment to 20%, a Republican Senate source told CNN.

Mnuchin’s comments came as he urged Republican senators to act on economic stimulus measures totaling $1 trillion designed to avert that kind of worst case scenario. A 20% unemployment rate would be double the unemployment rate during the Great Recession, the highest in the US since the Great Depression, and it would leave more than 32 million Americans out of a job based on the current US labor force.

During the Great Recession of 2008 to 2009, approximately 9 million people lost their jobs. Losses this time around could far exceed that total if economic stimulus is not enacted.

I am not sure if it can get any worst than this; potentially lose your life, lose kin, lose your job, lose your healthcare, or lose whatever resource you might have.

Senate Republican Stimulus for People

– a direct payment to qualified Americans of up to $1,200. Married couples could get $2,400. Taxpayers who earn more than $75,000 annually will begin to see that payment reduced by $5 for every $100 they earn over the $75,000 threshold, with those who make more than $99,000 getting nothing. Families with children would get $500 per child.

While a Treasury Department outline circulated earlier in the week had called for two payments from the IRS — one each in April and May — the Senate GOP proposal only calls for one check at this time.

– The poorest families, those with no federal income tax liability, would see smaller benefits, though the minimum would be set at $600. About 22 million people earning under $40,000 a year would see no benefit under the GOP plan, according to an initial analysis by Ernie Tedeschi, a former Obama administration economist.

Business is the big winner under the Republican Senate Plan. I am waiting for a cohesive Democratic plan. Perhaps, I missed it?

ACA Healthcare Insurance

There are some things which will help people who lose their jobs and subsequently healthcare. Andrew Sprung at xpostfactoid also writes at Health Insurance Org. Today he wrote about “Uninsured in a pandemic? Seek help – it’s likely available.”

1. If you lose your job – and your employer-sponsored health insurance with it – you become eligible for a special enrollment period in the ACA marketplace. You can apply through HealthCare.gov if you’re in one of the 38 states that use the federal website. Twelve states and Washington D.C. run their own ACA exchanges. You can access those sites from this list. You can also get assistance from a licensed broker through this site.

2. If your estimated income for the year – including expected unemployment insurance – is below 400% of the federal poverty level ($49,960 for an individual, $67,640 for a couple, $103,000 for a family of four), you probably qualify for advanced premium tax credits – aka premium subsidies – a federal subsidy that picks up much or most of the monthly premium for plans offered on the exchange.

3. In the 36 states (and the District of Columbia) that have implemented the ACA Medicaid expansion, you should qualify for Medicaid if you lose your job – or you’re a freelancer who loses much of your income – and your monthly income going forward is below 138% of the federal poverty level ($1,468 for an individual, $3,013 for a family of four*). Apply through your state Medicaid office or website.

4. Important note for those whose income falls abruptly, e.g., to zero: While the ACA marketplace (HealthCare.gov for 38 states, state-based exchanges in 12 states and D.C.) calculates subsidy eligibility and Medicaid eligibility on the basis of yearly income, State Medicaid departments determine Medicaid eligibility on the basis of monthly income. Accordingly, if your earnings before layoff or loss of work were substantial, and your income going forward is zero or below the Medicaid threshold, you should apply for Medicaid through a state office or website, not through the ACA marketplace.

The main provider for healthcare insurance may be Medicaid. Pre-Medicaid expansion, rule of thumb was about 1 million Medicaid enrollment increase for every 1 point increase in unemployment rate. More than likely higher with many more parents and other adults potentially eligible in expansion states (Prof. Edwin Park, Georgetown).

Hopefully, the better souls and minds prevail in determining what stimuli is used to assist people. If you need some assistance in finding information, please ask and I will assist.

Sources of Information which will lead to other place:

Uninsured in a pandemic? Seek help – it’s likely available,” Health Insurance Org., Andrew Sprung, March 20, 2020

The ACA as recession insurance, revisited,” Xpostfactoid Blog, Andrew Sprung, March 20, 2020

CR’s Guide to the Coronavirus freebie informan

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FDA Approves Malaria Drugs for COVID-19 Treatment – Update 2

It is a start, maybe. Remdesivir is being touted as a potentially more effective drug.

The Chinese had reported there were several pharmaceuticals which appeared to work also and in particular drugs for malaria, Chloroquine and HydoxyChloroquine. I had mentioned this earlier in the week (or even earlier) in a post and then again in two separate comments.

One small clinical test (preliminary trial with 24 -36 patients) in France had positive results recently as reported March 17, 2020. HydoxyChloroquine Would Be Effective According to Professor Roault of the IHU in Marseille,” after the first limited Test as reported by EN24 on March 17, 2020. With the use of the antibiotic Azithromycin to treat pneumonia a bacterial infection resulting from the virus infection, the test results were ~75% positive.

Remdesivir appears to have worked in a limited number of cases also. An issue which we are missing is bacterial infection following viral infection. The Chinese followed up their treatment using Chloroquine and HydoxyChloroquine (decades old drug) with antibiotics for Strep. The French study instead uses Azithromycin for treatment of the resulting pneumonia, etc. Although the French clinical test had a success rate of 75%, they are calling for a larger load testing. For Italy, it may present an opportunity sooner than Remdesivir.

And today, Trump is back on the air: Malaria Drug for Coronavirus Has Been Approved by FDA (?)

President Donald Trump announced Thursday the Food and Drug Administration (FDA) has approved hydroxychloroquine—a drug used to treat malaria, rheumatic diseases and other conditions—for COVID-19.

As the COVID-19 pandemic spreads around the world, scientists are scrambling to identify treatments that may be effective against the disease. Hydroxychloroquine—a common derivative of chloroquine—is among those touted as most promising by some experts.

HydoxyChloroquine Would Be Effective According to Professor Roault of the IHU in Marseille after the first limited Test,” EN24, March 17, 2020

Donald Trump Says Malaria Drug for Coronavirus Has Been Approved by FDA, Newsweek, Aristos Georgiou, March 19, 2020

Update 3/19:  As Trump claimed HydoxyChloroquine was approved, FDA Head Steven Hahn countered Trump’s claim, stating the president had “directed the FDA to take a closer took” at whether the drug could help people with coronavirus. Indicating the FDA had not approved HydoxyChloroquine for use on a Coronaviral disease/disorder yet, Mr. Hahn called for large clinical trials to ascertain HydoxyChloroquine’s  effectiveness in treatment.

FDA contradicts Trump on status of potential coronavirus drug,” Financial Times, Demetri Sevastopulo (Washington) and Hannah Kuchler (New York), March 19, 2020

Update 3/20: Robert Waldman – “MDs can prescribe chloroquine and hydroxychloroquine for Covid 19 right now. The FDA doesn’t and can’t regulate off label prescriptions. Large trials (with young subjects) might be OK, but that does NOT mean Drs should wait for the results before prescribing hydroxychloroquine. It has known side effects which are mild except if it is taken continuously for years (anti malaria profilassi). I think the current evidence is enough that it should be given to everyone who is not in the trials’ control group. I am quite confident of this and know of no arguably valid argument against doing so.”

Robert’s Comment is true and something I did not think of while writing.

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Moscow Mitch was hoping the fever would break

The closing remarks of Moscow Mitch McConnell statement before the vote to spare Donald John Trump his presidency.

He was talking about “factional fever” that the “framers” referred to as a concern for majorities acting in a partisan manor.  And yet, here we are.

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Let’s get real about coronavirus testing . . .

We do not know how severe the covid-19 epidemic will be or how much economic and social pain it will cause, but it clearly has the potential to kill hundreds of thousands or even millions of Americans, and the economic consequences could include a deep recession and even a financial crisis that will cause misery to tens of millions of people.

Testing is key to getting the epidemic under control, and it is not clear to me that policymakers are being nearly as aggressive about expanding testing capacity as they should be.  Think of two alternative testing strategies.  One strategy is to selectively test people who have symptoms or who may have been exposed to someone with the disease.  The alternative strategy is to develop the ability to do mass screenings for the virus among the general population.  (There are various intermediate strategies one can imagine, such as doing mass screenings in local areas with a high incidence of disease.)  Of course, selective testing is the place to start, but the ability to do mass screenings would allow us to pro-actively identify and isolate almost all carriers and would thus avoid the need for widespread social isolation which is wreaking havoc on the economy.  Selective screenings, in contrast, may or may not be able to contain the epidemic sufficiently to allow normal economic activity to resume.

I am not sure what is being done to expand our testing capacity, but if we want to develop the ability to do mass screenings, we need to make it a priority nowThe government will need to contract with equipment manufacturers and other suppliers (of reagents, swabs, protective gear, etc.) for large capacity commitments on a short timeline.  I have no idea what this would cost or even if it is feasible, but if there is even a small chance that the epidemic will last for six months or return next winter, it seems that a $10 or $20 billion investment in testing capacity would be short money.

The Democrats should jump on this as they take up the next coronavirus response bill.  Not only is it good policy, it will give them an opportunity to highlight the fumbling, timid response of the Trump administration to the crisis.

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